Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
Question
Symptoms of various gastrointestinal (GI) and Hepatobiliary disorders often overlap, making diagnosis and treatment challenging. For example, symptoms such as vomiting, constipation, and bloating are non-specific and could also be the result of underlying medical history or current prescription drug use. As a nurse, you could be potentially responsible for providing care to a patient who may present with non-specific symptoms related to the gastrointestinal and hepatobiliary systems.
How would you proceed to care for this patient? What type of drug therapy might you recommend, not knowing the current medical history or prescription drug use? Are there certain drugs you should avoid in ensuring a drug-drug interaction does not occur?
CASE STUDY ASSIGNMENT: Ms. DC is a 46- year-old female who presents with a 24-hour history of Right- upper- quadrant pain. She states the pain started about 1 hour after a large dinner she had with her family. She has had nausea and on instance of vomiting before presentation. PAST MEDICAL HISTORY includes: vital : Temp: 98.8F, Diabetes mellitus,Type11, Wt: 202lbs, Ht 5' 8", DVT-Caused by oral BCPs, BP: 136/82, Heart rate: 82, Current medications: Lisinopril 10mg daily, WBC: 13000/MM, HCTZ 25MG Daily, Total bilirubin: 0.8mg/dl, Allopurinol 100mg daily, Direct bilirubin 0.6mg/dl , multivitamin daily, Alk Phos:100u/l, AST: 45, ALT:30 Allergies: Latex, Codeine, Amoxicillin, Physical examination: GI: bilateral non-distended, minimal tenderness, skin: bilateral warm and dry, Neuro: Alert and oriented, Psych: bilateral appropriate mood.
TO Prepare:(a) Reflect on the patient's symptoms, medical history, and drug currently prescribed.
(b) Think about the possible diagnosis for the patient. Consider whether the patient has a disorder related to the gastrointestinal and hepatobiliary system or whether the symptoms are the result of a disorder from another system or other factors, such as pregnancy, drugs, or a psychological disorder. (c) Consider an appropriate drug therapy plan based on the patient's history, diagnosis, and drugs currently prescribed.
ASSIGNMENT INSTRUCTIONS ARE: (1) Write a 1 to 2 -page paper that addresses the following.
(2) Accurately and clearly explain in detail the diagnosis for the patient, including an accurate and thorough rationale for the diagnosis that supports clinical judgment.
(3) Accurately and completely describe in detail an appropriate therapy plan based on the patient's history, diagnosis, and drug currently prescribed.
(4) Provide an accurate, clear, and detailed justification for the recommended drug therapy plan for this patient. Be specific and provide detailed examples that fully support the justification provided. (5) Include a title page, Introduction, Summary, and references. (6) Use correct grammar, spelling, and punctuation with no errors. (7) please answer all parts of the assignment questions with reflective analysis.
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Solution
Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
Introduction to Gastrointestinal and Hepatobiliary Disorders
Gastrointestinal disorders are a group of conditions that affect the stomach, intestines, liver, gallbladder or pancreas. These can be caused by infection with viruses or bacteria (gastritis), changes in diet (dyspepsia), inflammation (colitis), or autoimmune disorders (Crohn’s disease). Hepatobiliary disorders are a group of conditions that affect the liver, gallbladder or pancreas. These can be caused by infection (hepatitis), inflammation (cholangitis), or blockage of the bile ducts (obstructive jaundice). Treatment for these disorders depends on the underlying cause including medications, surgery or other interventions. The essay will focus on pharmacotherapy for gastrointestinal and hepatobiliary disorders.
Reflection on Ms. DC’s Medical History, Symptoms, and Drugs Prescription
Ms. DC is a middle-aged woman. She weighs 202lbs, and her height is 5’ 8”, which shows that she is overweight with a BMI of around 29kg/m2. According to her medical history, she has a history of diabetes type 2, and her BP of 136/82mmHg shows that she has a history of high blood pressure. Considering Ms. DC is overweight, which can be one factor attributed to her diabetes and hypertension. She also has a history of DVT (deep vein thrombosis), which is linked to her use of birth control, a risk factor for DVT. Ms. DC is under various medications such as bilirubin, allopurinol, Alk Phos, AST, and ALT to manage her conditions. On her visit, she reported pain in the right-upper-quadrant for the last 24 hours after taking a large dinner. She also reports nausea and vomiting. Physical examination shows minimal tenderness and bilateral non-distended in her GI.
Possible Diagnosis
The symptoms presented by Ms. DC can be classified as non-specific symptoms since they can be linked to more than one disorder. Also, her symptoms can result from the side effects of her medications. A closer look at her symptoms shows the possibility of gastrointestinal disorder and disorder of a hepatobiliary system (Drossman, 2016). She reports pain in her right upper quadrant for the last 24hrs. It is hard to make specific diagnoses for the pain in the right upper quadrant since many organs can be the cause of pain. The right upper quadrant houses essential organs such as the right kidney, stomach, small intestines, large intestine, liver, gallbladder, and pancreas (Avegno & Carlisle, 2016). Pain in the right-upper-quadrant can be a disorder symptom in any of the above organs. However, the pain started after taking a heavy meal; therefore, the pain is a symptom of gastrointestinal disorder.
The physical examination shows bilateral non-distended GI with minimum tenderness. Abdominal tenderness and bilateral non-distended GI can be linked to inflammation or an acute process in the surrounding organs (Mullarkey et al., 2021). An acute process can be a result of pressure from either a blocked or twisted organ. In Ms. DC’s case, that pressure can be a result of binge eating. The other symptoms presented by Ms. DC are nausea and an instance of vomiting. Most of the medication Ms. DC is taking has nausea and vomiting as side effects. But, considering these symptoms happened after large eating and after feeling pain in the right upper quadrant, it means they are more linked to gastrointestinal disorders than side effects of her medications (Basnayake et al., 2020). Therefore, considering the past events, Ms. DG engaged in, the symptoms presented, including physical examination and the timing of symptoms appearance, the possible diagnosis for Ms. DC is a gastrointestinal disorder such as blockages or excess pressure in the right upper quadrant due to binge eating.
Drug Therapy Plan and Justification
In Ms. DC’s case, the drug therapy should focus on the management of gastrointestinal disorders, precisely gastrointestinal decontamination and indigestion. The symptoms presented by Ms. DC point out to digestive troubles causing the pain in right-upper-quadrant. Drug therapy should involve drugs in the categories of functional bowel disorder agents, anti-nausea, antacids, GI stimulants, and digestive enzymes (Avegno & Carlisle, 2016). To justify the above drug therapy plan, I considered the medical history and accompanying medications and the possible complications resulting from the stated conditions, and medications do not include pain in the right upper quadrants. Also, the timing of symptoms points away from medical history since they started soon after binge eating. Therefore, the priority should be the management of underlying gastrointestinal disorders followed by more tests such as CT scans, urine tests, ultrasound, and blood tests to rule out the presence of other medical complications.
Conclusion
In conclusion, Ms. DC is a 38-year-old female who presented with pain in the right upper quadrant for the last 24hrs. The pain started after taking a large meal, and she also reports nausea and vomiting. The physical examination shows bilateral non-distended GI with minimum tenderness. Considering her medical history of binge eating and the timing of symptom appearance, it is safe to say that Ms. DC is suffering from gastrointestinal disorders. Therefore, drug therapy should focus on the management of gastrointestinal disorders. The drugs in the category of functional bowel disorder agents, anti-nausea, antacids, GI stimulants, and digestive enzymes will help Ms. DC relieve her symptoms.
References
Avegno, J., & Carlisle, M. (2016). Evaluating the patient with right upper quadrant abdominal pain. Emergency Medicine Clinics, 34(2), 211-228.
Drossman, D. A. (2016). Functional gastrointestinal disorders: history, pathophysiology, clinical features, and Rome IV. Gastroenterology, 150(6), 1262-1279.
Basnayake, C., Kamm, M. A., Salzberg, M. R., Wilson-O’Brien, A., Stanley, A., & Thompson, A. J. (2020). Delivery of care for functional gastrointestinal disorders: a systematic review. Journal of Gastroenterology and Hepatology, 35(2), 204-210.
Mullarkey, M., Wilcox, C. M., & Edwards, A. L. (2021). Factitious Gastrointestinal Bleeding: A Case Series and Review. The American Journal of the Medical Sciences, 362(5), 516-521.
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